|Year : 2022 | Volume
| Issue : 1 | Page : 29-32
Asymptomatic bacterial vaginosis and associated risk factors among undergraduate in a tertiary institution in Ogun State, Nigeria
Babatunde Tayo1, Charles John Elikwu1, Tinuade Adesola Ajani2, Chika Celen Okangba1, Chinenye Gloria Anaedobe23, Victor Ugochukwu Nwadike1, Opeoluwa Akinyele Shonekan1, Azubuike Chidiebere Omeonu1, Oluwaseun Bibitayo Faluyi1, Grace Imangbe1, Bassey Imaobong Udoh1, Chimdi Eleweke1, Onyinyechi Okam1, Kelechi Emeka Nwonyi1, Abimbola Oladayo1, Folarin Atalabi1
1 Department of Medical Microbiology School of Basic Clinical Sciences, Benjamin Carson(snr.) College of Health and Medical Sciences, Babcock University, Ilishan-, Remo
2 Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Oyo State, Nigeria
3 Department of Medical Microbiology, University of Abuja, Federal Capital territory, Abuja, Nigeria
|Date of Submission||24-Jun-2021|
|Date of Decision||01-Oct-2021|
|Date of Acceptance||27-Dec-2021|
|Date of Web Publication||3-Aug-2022|
Dr. Tinuade Adesola Ajani
Department of Medical Microbiology and Parasitology, University College Hospital, Ibadan, Oyo State
Source of Support: None, Conflict of Interest: None
Background: Bacterial vaginosis (BV) is a disease condition in women with adverse health outcomes. Proper clinical diagnosis of BV is difficult because a larger percentage of women are asymptomatic until they come down with its sequaele. Therefore, this study was aimed to determine the prevalence of asymptomatic BV among undergraduate female students of Babcock University in Ogun State Nigeria and to detect the risk factors associated with it. Materials and Methods: A descriptive cross-sectional study involving 200 asymptomatic undergraduate female student of Babcock University from September 2018 to November 2019. Information was obtained, using structured questionnaire, on sociodemographic and behavioral characteristics considered risk factors of the respondents. High vaginal swabs were collected from each of the participants, made into thin smears and were Gram stained. Modified Nugent criteria were used to analyze the specimen and make a diagnosis of BV. The data were analyzed by IBM Statistical Package for the Social Sciences software version 20 (SPSS Chicago, IL, USA). Results: The prevalence of asymptomatic BV among the study participants was 35/200 (17.5%). Vaginal douching (Odd's ratio [OR] = 3.3, 95% confidence interval [CI]: 1.49–7.33), smoking (OR = 3.2, 95% CI: 1.16–8.80), previous history of reproductive tract infection (OR = 16, 95% CI 3.99–64.11), and wearing of nylon underwears (OR = 5.21, 95% CI: 1.23–21.88) were the factors with increased likelihood of BV on multivariate analysis. Conclusion: The prevalence of BV among the asymptomatic population in this study is high. The risk factors found suggest that there should be preventive program strategies such as education on risky behaviors.
Keywords: Asymptomatic, bacterial vaginosis, prevalence
|How to cite this article:|
Tayo B, Elikwu CJ, Ajani TA, Okangba CC, Anaedobe2 CG, Nwadike VU, Shonekan OA, Omeonu AC, Faluyi OB, Imangbe G, Udoh BI, Eleweke C, Okam O, Nwonyi KE, Oladayo A, Atalabi F. Asymptomatic bacterial vaginosis and associated risk factors among undergraduate in a tertiary institution in Ogun State, Nigeria. Ann Trop Pathol 2022;13:29-32
|How to cite this URL:|
Tayo B, Elikwu CJ, Ajani TA, Okangba CC, Anaedobe2 CG, Nwadike VU, Shonekan OA, Omeonu AC, Faluyi OB, Imangbe G, Udoh BI, Eleweke C, Okam O, Nwonyi KE, Oladayo A, Atalabi F. Asymptomatic bacterial vaginosis and associated risk factors among undergraduate in a tertiary institution in Ogun State, Nigeria. Ann Trop Pathol [serial online] 2022 [cited 2023 Mar 31];13:29-32. Available from: https://www.atpjournal.org/text.asp?2022/13/1/29/353196
| Introduction|| |
Bacterial vaginosis (BV) is a clinical condition caused by vaginal microbiota that is lactobacilli-deficient and dominated by BV-associated organisms such as Ureaplasma urealyticum, Gardnerella vaginalis, Peptostreptococcus, Bacteroides, Mobiluncus, Prevotella, Fusobacterium, Eubacterium, and Veillonella. The decrease in lactobacillus predominantly those producing hydrogen peroxide leads to decreased lactic acid production in the vagina., This will result in increased alkalinity of the vagina, thereby favoring the increase in growth of the other species of bacteria. BV is characterized by foul smelling vaginal discharge and is the most common cause of vaginal discharge in women of child-bearing age. BV varies from 15% to 30% among nonpregnant women in developed countries.,,, A study in India reported 32.8% while 21%–29% was reported from Kenya.,, In Nigeria, the prevalence reported from various studies in different parts of the country varies from 17% to 51%.,,,,, BV is associated with many sequaele such as endometritis, pelvic inflammatory disease, cervicitis, HIV, postoperative infection, and adverse pregnancy outcomes., BV has also been associated with the risk of sexually transmitted infection (STI). Proper determination of BV is difficult because a larger percentage of women are asymptomatic. The pathogenesis of asymptomatic BV is not well understood, but it was reported that treatment of asymptomatic BV has led to reduction in Chlamydia infection. Considering the risk associated with BV and improved health outcome reported in treatment of people with asymptomatic BV, then the knowledge of the prevalence of asymptomatic BV is important in reducing the disease burden. Therefore, the aim of this article was to determine the prevalence of asymptomatic BV among undergraduate female students of Babcock University in Ogun State Nigeria and to detect the risk factors associated with it.
| Materials and Methods|| |
This is a cross-sectional study in which 200 asymptomatic undergraduate female students of Babcock University were enrolled between September 2018 and November 2019. Ethical approval was obtained from Babcock University Health Research ethics committee Ilishan-Remo, Ogun State, Nigeria. The minimum sample size was calculated by Leslie Fischer's formula. The prevalence of 14.6% from a previous study was used and confidence limit was set at 5%. Participants were recruited by simple random technique. The inclusion criteria were women of child-bearing age 15–35 years while exclusion criteria were vaginal discharge, itching, pain during intercourse and use of antibiotics in the last 6 weeks. Participants filled written informed consent while Semi-structured interviewer-administered questionnaire was used to obtain sociodemographic and associated predisposing factors to BV. High vaginal swabs were collected from each of the participants and made into thin smears on glass slides. A Gram stain was done on smears made from specimens and then viewed under the light microscope at ×40 and ×100 respectively. Nugent scoring criteria was used to analyze specimen. scores of 7–10 were indicative of BV, scores of 4–6 were intermediate and scores of 0–3 were negative. Using the modification to the Nugent criteria, scores of 4–6 with the presence of clue cells were considered positive while scores of 4–6 with the absence of clue cells were considered negative. The data were analyzed by IBM Statistical Package for the Social Sciences software version 20 (SPSS Chicago, IL, USA). The categorical variables were presented in proportions while test of significance was further analyzed using Chi-square.
| Results|| |
A total of 200 respondents participated in the study. [Table 1] describes the sociodemographic and bivariate analyses of the characteristics of the 200 participants. The mean age was 21 ± 2.74, with range of 17–25 years. The prevalence of asymptomatic BV among the study participants was 35/200 (17.5%).
|Table 1: Sociodemographic and behavioural characteristics of the participants|
Click here to view
Participants practicing vaginal douching, smoking, with previous history of STI and wearing nylon underwears had increased likelihood of having BV on logistic regression [Table 2].
| Discussion|| |
The prevalence of BV in this index study is similar to previous reports in Nigeria by Ibrahim et al., Adinma et al., and Aduloju et al., respectively.,, However, the prevalence rate documented by Awoniyi et al., Olowe et al., and Odunuga et al., respectively, were higher than the prevalence of this study.,, In sub-Saharan Africa, higher prevalent rates such as (32.5%) in Zimbabwe, (37%) in Kenya, and (38%) in Botswana were reported.,, The variations in prevalence rate might be attributed to a lot of factors such as study population, genital hygiene, sexual activities, and sociodemographic characteristics of individuals.,, The prevalence derived from this study is quite high for asymptomatic population. Previous studies have also reported high prevalence rates among asymptomatic individuals., Although there are a lot of arguments about whether to screen or treat asymptomatic BV or not. Considering the high prevalence observed among the asymptomatic in this and other studies, the adverse outcome of this condition individuals in women of childbearing age, screening, and treatment of asymptomatic BV will go a long way to reduce its burden.
Majority of the participants (15%) with BV in this study had never had sex before. This finding is consistent with previous studies that had reported BV among women that had never had sex before.,, These findings suggest that sex might not be a necessity for BV. However, the actual relationship of sexual activity or sex behaviors with BV are not very clear because, as much as, BV has been found in people who had no sex before, so also factors such as multiple sex partners and new present sex partners have been reported to be associated with BV., In this study, present number of sex partners lost its statistical significant with BV on multivariate analysis. This finding is consistent with that of Bitew et al.
Participants with a history of reproductive tract infections (RTI) had 16 times increased likelihood to have BV in our study. This finding is similar to previous reports from Kenya and Rwanda. The explanation for this might be the alteration in vaginal PH from acidity to alkalinity by the metabolism of the pathogens responsible for RTIs.
Participants who douched were 3.3 times more likely to have BV in this present study. Our findings are in congruent with previous studies that have reported strong statistical relationship between douching and BV.,,, However, some other literatures did not find any association between douching and BV., The explanation given by these researchers is that issue of douching and BV maybe more related to the agents or substances used for douching. Smoking was also found to be associated with BV in this study and this finding is similar to that of Manandhar et al,, although another study in Sweden did not find a significant association., However it has been reported that smoking reduces hydrogen peroxide–producing lactobacilli and this might be a good explanation for the association of smoking and BV. Our study did not find any association between condom use and BV and this report is similar to that of Mascarenhas et al. Our study is not without limitation as we did not asses treatment outcomes in participants with asymptomatic BV.
| Conclusion|| |
In conclusion, the prevalence of BV among the asymptomatic population in this study was high. Vaginal douching, previous RTI, smoking, and use of nylon underwear were associated risk factors. Therefore, screening of asymptomatic population is advocated as early diagnosis and treatment might help to reduce the adverse outcomes of BV among females.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Abdullateef RM, Ijaiya MA, Abayomi F, Adeniran AS, Idris H. Bacterial vaginosis: Prevalence and associated risk factors among non-pregnant women of reproductive age attending a Nigerian tertiary hospital. Malawi Med J 2017;29:290-3.
Aduloju OP, Akintayo AA, Aduloju T. Prevalence of bacterial vaginosis in pregnancy in a tertiary health institution, South Western Nigeria. Pan Afr Med J 2019;33:9.
Nkosinathi J, Dhayendre M, Thandeka N, Raesetja T, Motshedisi S, Megeshnee N, et al
. Asymptomatic Bacterial Vaginosis in Pregnancy and Missed Opportunities for Treatment: A Cross-Sectional Observational Study. Infect Dis Obstet Gynecol 2019;2019:1-7.
Rajshree S, Manju M, Leena S, Vikrant S. Effects of bacterial vaginosis on perinatal outcome. J Evol Med Dent Sci 2014;3:2040-6.
Tachawatcharapunya S, Chayachinda C, Parkpinyo N. The prevalence of bacterial vaginosis in 103 asymptomatic pregnant women during early third trimester and the pregnancy complications. Thai J Obstet Gynaecol 2017;25:96-103.
Li XD, Tong F, Zhang XJ, Pan WJ, Chen ML, Wang CC, et al.
Incidence and risk factors of bacterial vaginosis among pregnant women: A prospective study in Maanshan city, Anhui Province, China. J Obstet Gynaecol Res 2015;41:1214-22.
Sabour S, Arzanlou M, Vaez H, Rahimi G, Sahebkar A, Khademi F. Prevalence of bacterial vaginosis in pregnant and non-pregnant Iranian women: A systematic review and meta-analysis. Arch Gynecol Obstet 2018;297:1101-13.
Aggarwal AK, Kumar R, Gupta V, Sharma M. Community based study of reproductive tract infections among ever married women of reproductive age in a rural area of Haryana, India. J Commun Dis 1999;31:223-8.
Thomas T, Choudhri S, Kariuki C, Moses S. Identifying cervical infection among pregnant women in Nairobi, Kenya: Limitations of risk assessment and symptom-based approaches. Genitourin Med 1996;72:334-8.
Wariso KT, Igunma JA, Oboro IL, Olonipili FA, Robinson N. Prevalence of bacterial vaginosis among patients with vulvovaginitis in a tertiary hospital in port Harcourt, Rivers State, Nigeria. Asian J Med Health 2017;7:01-8.
Nigeen W, Bhat AS, Gulzar K, Taing S. Correlation of bacterial vaginosis with preterm labour: A case control study. Int J Reprod Contracept Obstet Gynecol 2015;4:1868-74.
Ibrahim SM, Bukar M, Galadima GB, Audu BM, Ibrahim HA. Prevalence of bacterial vaginosis in pregnant women in Maiduguri, North-Eastern Nigeria. Niger J Clin Pract 2014;17:154-8.
] [Full text]
Adesiji YO, Taiwo SS, Adekanle DA, Oboro VO, Fayemiwo SA, Opaleye OO. Bacterial vaginosis and pregnancy outcome in Osogbo, Nigeria. Res J Med Sci 2007;1:195-8.
Lennox JA, Abbey SD, Udiba D, Mboto CI, Ikpoh IS, Akubuenyi FC. Prevalence of vaginitis and vaginosis among University of Calabar female students. J Public Health Epidemiol 2013;5:167-72.
Muzny CA, Schwebke JR. Asymptomatic bacterial vaginosis: To treat or not to treat? Curr Infect Dis Rep 2020;22:32.
Araoye MO. Subjects selection. In: Research Methodology with Statistics for Health and Social Sciences. Ilorin, Nigeria: Nathadex Publishers; 2003. p. 115-29.
Ajayi VD, Sadauki HB, Randawa A, Afolabi BM. Bacterial vaginosis is a common vaginal among first – Time antenatal clinic: Evidence health facility in North-West Nigeria. J Prev Infect Control 2016;2:2.
Nugent RP, Krohn MA, Hillier SL. Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. J Clin Microbiol 1991;29:297-301.
Verstraelen H, Verhelst R. Bacterial vaginosis: An update on diagnosis and treatment. Expert Rev Anti Infect Ther 2009;7:1109-24.
Adinma JI, Okwoli NR, Unaeze A, Unaeze N. Prevalence of Gardnerella vaginalis in pregnant Nigerian women. Afr J Reprod Health 2001;5:50-5.
Awoniyi AO, Komolafe OI, Bifarin O, Olaniran O. Bacterial vaginosis among pregnant women attending a primary health care center in Ile-Ife, Nigeria. Glob Adv Res J Med Med Sci 2015;4:057-60.
Olowe OA, Makanjuola OB, Olowe R, Adekanle DA. Prevalence of vulvovaginal candidiasis, trichomoniasis and bacterial vaginosis among pregnant women receiving antenatal care in Southwestern Nigeria. Eur J Microbiol Immunol (Bp) 2014;4:193-7.
Odunuga AO, Mensah-Agyei GO, Oyewole IO. Nugent scores of female students from Babcock University, Southwestern Nigeria. Nat Sci 2014;12:150-4.
Bitew A, Abebaw Y, Bekele D, Mihret A. Prevalence of bacterial vaginosis and associated risk factors among women complaining of genital tract infection. Int J Microbiol 2017;2017:4919404.
Marx G, John-Stewart G, Bosire R, Wamalwa D, Otieno P, Farquhar C. Diagnosis of sexually transmitted infections and bacterial vaginosis among HIV-1-infected pregnant women in Nairobi. Int J STD AIDS 2010;21:549-52.
Romoren M, Velauthapillai M, Rahman M, Sundby J, Klouman E, Hjortdahl P. Trichomoniasis and bacterial vaginosis in pregnancy: Inadequately managed with the syndromic approach. Bull World Health Organ 2007;85:297-304.
Koumans EH, Sternberg M, Bruce C, McQuillan G, Kendrick J, Sutton M, et al.
The prevalence of bacterial vaginosis in the United States, 2001-2004; associations with symptoms, sexual behaviors, and reproductive health. Sex Transm Dis 2007;34:864-9.
Bahram A, Hamid B, Zohre T. Prevalence of bacterial vaginosis and impact of genital hygiene practices in non-pregnant women in Zanjan, Iran. Oman Med J 2009;24:288-93.
Krauss-Silva L, Almada-Horta A, Alves MB, Camacho KG, Moreira ME, Braga A. Basic vaginal pH, bacterial vaginosis and aerobic vaginitis: Prevalence in early pregnancy and risk of spontaneous preterm delivery, a prospective study in a low socioeconomic and multiethnic South American population. BMC Pregnancy Childbirth 2014;14:107.
Yen S, Shafer MA, Moncada J, Campbell CJ, Flinn SD, Boyer CB. Bacterial vaginosis in sexually experienced and non-sexually experienced young women entering the military. Obstet Gynecol 2003;102:927-33.
Jespers V, Crucitti T, Menten J, Verhelst R, Mwaura M; Vagina Biomarkers Study Group, et al
. Prevalence and correlates of bacterial vaginosis indifferent sub-populations of women in sub-Saharan Africa: A cross-sectional study. PLoS One 2014;9:e109670.
Elgantri R, Mohamed A, Ibrahim F. Diagnosis of bacterial vaginosis by amsel criteria and gram stain method. Sebha Med J 2010;9:20-7.
Modak T, Arora P, Agnes C, Ray R, Goswami S, Ghosh P, et al
. Diagnosis of bacterial vaginosis in cases of abnormal vaginal discharge: Comparison of clinical and microbiological criteria. J Infect Dev Ctries 2011;5:353-60.
Ranjit E, Raghubanshi BR, Maskey S, Parajuli P. Prevalence of bacterial vaginosis and its association with risk factors among nonpregnant women: A hospital based study. Int J Microbiol 2018;2018:8349601.
Adelaiye SM, Shittu SO, Olayinka AT. Characterization of bacterial vaginosis among HIV-positive and HIV-negative pregnant women. Int J Biomed 2015;5:141-6.
Achondou AE, Fumoloh FF, Aseneck AC, Awah AR, Utokoro AM. Prevalence of bacterial vaginosis among sexually active women attending the CDC central clinic Tiko, South West Region, Cameroon. Afr J Infect Dis 2016;10:96-101.
Manandhar R, Sharma J, Pokharel B, Shrestha B, Pradhan N. Bacterial vaginosis in Tribhuvan University Teaching Hospital. J Inst Med 2007;27:2-5.
Hellberg D, Nilsson S, Mårdh PA. The diagnosis of bacterial vaginosis and vaginal flora changes. Arch Gynecol Obstet 2001;265:11-5.
Mascarenhas RE, Machado MS, Costa e Silva BF, Pimentel RF, Ferreira TT, Leoni FM, et al.
Prevalence and risk factors for bacterial vaginosis and other vulvovaginitis in a population of sexually active adolescents from Salvador, Bahia, Brazil. Infect Dis Obstet Gynecol 2012;2012:378640.
[Table 1], [Table 2]